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American twice survives COVID-19; doctors caution about findings

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Posted: Tuesday, October 13, 2020. 9:12 am CST.

By Aaron Humes: Researchers say it is too early to tell if the case of an otherwise healthy Nevada man, 25, who caught and recovered from COVID-19 twice, represents a worrying new trend or is an explainable rarity, per Yahoo News.

The Washoe County native fell ill in late March with a sore throat, cough, headache, nausea and diarrhea when his workplace had been hit with an early outbreak during the pandemic before safety measures like the wearing of masks were in place. He was eventually tested positive on April 18, with symptoms resolving nine days later.

At the time, employees were required to test negative for COVID-19 twice before they would be allowed back to work, one of the researchers said, so he remained isolated at home. A month later, he began feeling poorly again. At the same time, there was an outbreak where one of his parents, also an essential worker, was employed.

On May 31, he went to an urgent care center, reporting fever, headache, dizziness, cough, nausea and diarrhea. On June 5, he went to see a doctor who found his oxygen levels dangerously low and had him hospitalized. Again, the man tested positive for the virus, even though he still had antibodies to the virus in his bloodstream.

Genetic differences between the viruses responsible for each of his infections suggested he was infected two separate times. The virus doesn’t mutate quickly enough within a single person to explain the differences between the two infections, the researchers found.

A parent living with the man also caught COVID-19 and was diagnosed on June 5.

The paper on the case reports it’s possible the man was reinfected because he was exposed to a higher dose of the virus the second time, perhaps from the family member.

His cough lingered and he suffered from shortness of breath and mental fog, and was on oxygen for six weeks after the second infection but has now fully recovered.

Reinfections imply so-called herd immunity cannot be obtained just through natural infection. If natural infection protects for only a few months, then it will be impossible for enough people to be protected simultaneously to reach herd immunity.

The moral of the case study, said co-author and a pathologist at the University of Nevada, Reno School of Medicine, Mark Pandori, is that even people who already have been sick with COVID-19 need to protect themselves by wearing a mask, avoiding large gatherings, washing hands frequently and maintaining social distance.

“You’re not invulnerable to this,” Pandori said. “In fact, you could get it worse the second time.”

The case is one of a handful – 22 worldwide – of persons confirmed re-infected with COVID-19 after catching it a first time. It raises questions about how long people are protected after being infected with the coronavirus that causes the disease, and potentially how protective a vaccine might be.

Pandori said such cases are tough to prove; his team coordinated early in the pandemic with members of the Washoe County Health District to look for repeat infections. They had the benefit of sequencing equipment on campus, as well as microbiologists, he said. And they got lucky finding someone who had been tested both times he was infected and cleared in between.

But they could not say why his infection was worse the second time, he noted.

The man caught a slightly different version of the virus the second time, according a genetic analysis of the man’s infections. It’s possible the second version was more dangerous, though there is no evidence of that, or that it was just different enough that his body didn’t recognize it, the paper said.

As for vaccines, experts say they can be designed to induce much higher levels of antibody and much longer lasting immunity, for at least a year or two, but are not 100 percent perfect until the virus disappears. Instead, protection fades gradually, so someone exposed to a huge dose of the virus might get re-infected within months, while others could be protected for years.

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